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Treatment for Heroin Addiction Can Be Difficult to Find, Experts Say

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People seeking treatment for heroin addiction face a number of obstacles, including a lack of treatment beds, expensive care, and insurance companies that refuse to pay for inpatient rehab, according to ABC News.

Most insurance companies will not pay for inpatient heroin detoxification or rehab because withdrawal from the drug is generally not deadly, according to Anthony Rizzuto, a provider relations representative at Seafield Center, a rehabilitation clinic on Long Island, N.Y. He says insurance companies either claim the patient does not meet the “criteria for medical necessity” for inpatient care, or they require the patient to first try outpatient rehab and “fail” before being considered for inpatient treatment.

Most experts say inpatient care is often needed for a person addicted to heroin. Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps, kicking movements and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose, and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health can be fatal.

The symptoms of withdrawal are so bad that many people go back to using heroin, often with deadly consequences. Even people who are able to stop using heroin without treatment often relapse. They may overdose because they use as much heroin as they did before, but their system can’t handle the same level of drug as before they went through withdrawal.

Even patients who do get some insurance coverage for heroin treatment generally don’t get 30 days in a residential center. The average duration is 11 to 14 days, according to Tom McLellan, CEO of the nonprofit Treatment Research Institute in Philadelphia. After insurance companies stop paying, facilities discharge patients, even if they are not done with treatment.

The average cost of a 30-day inpatient stay is about $30,000.

6 Responses to this article

  1. Habib Costas / May 15, 2014 at 3:03 pm

    So if detox is not deadly, insurance companies won’t pay for it. This sounds like an invitation for things to get much worse and more expensive before they cover anything.

  2. Avatar of Charles Johnston
    Charles Johnston / April 17, 2014 at 6:59 pm

    The answer is Ibogaine. It is literally a treatment for drug addiction and not just a bandaid. It’s cost effective, it’s addiction effective, and it actually helps you deal with the internal struggle. One day we will look back and wonder why we were ignoring something that was right in front of us. Obviously drug companies want to keep us on Methadone but we should be looking for solutions not just ways to cover up the problem.

  3. Avatar of Dexter Brown
    Dexter Brown / April 14, 2014 at 4:26 am

    Inpatient care is most important for a person addicted to heroin. I think in this case, the state governments should take some initiatives, subsidizing the costs.

  4. Michael Rizzi / April 10, 2014 at 12:17 pm

    Firstly, I agree with Robin, both on her statement and question.
    Secondly, given patient history, “detox” may not be the indicated level of care. There are opportunities for outpatient opioid withdrawal (detox) in most “methadone” programs and the process is generally longer than most inpatient options. The advantage – the longer the service, the greater the engagement and retention in treatment. The same argument holds true for maintenance, and, for most “chronic” illnesses. Establish a reasonable and effective recovery plan, take the right medication at the right dose for as long as necessary, and develop a healthy and supportive network.
    Lastly, cost. Many patients could participate in MAT (methadone) for 6-7 years for the cost of one 30-day inpatient stay at $30,000.

  5. Robin Robinette / April 9, 2014 at 6:56 pm

    AGAIN, NO mention of the standard of care which is medication assisted treatment, either methadone or buprenorphine. Come ON Join Together! Couldn’t you at least add a comment on the article noting the absence of reference to the MAIN treatment for opioid addiction??????

  6. Barry Schecter / April 9, 2014 at 2:31 pm

    As I read the above posts, and I see how treatment for Heroin Addiction is so difficult to find, I then read about how the Largest Health Insurer in Massachusetts is pleased to say how they have cut Narcotic prescriptions. Does anyone that has any experience treating Addiction think that the people that can’t get licit opiates just stop, or do they turn to illicit drugs? My experience tells me that if I didn’t know better, this was some sort of very sad joke
    Prescription use is monitored very closely through states that utilize ISTOP to check Rx’s. As prescriptions became more difficult to get, is it merely ironic that the availability of cheap, potent heroin abounds.
    The Health Insurer’s reply? Your patient has not failed at outpatient treatment. Can’t approve inpatient rehab until they fail at outpatient. I would like to be informed by someone that has successfully won a lawsuit for such illogical requirements. Is that done anywhere else in Healthcare? And people wonder why addiction treatment has difficulty succeeding?

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